Military medical providers may not understand their duties to maintain the confidentiality of sexual-assault victims because of outdated command policies that conflict with or fail to mention how to deal with “restricted” reports, according to a Government Accountability Office report.

Service members and dependents who are sexually assaulted have the option of making a restricted report and, confidentially, getting physical and mental health care without triggering an intrusive investigation by law enforcement or the chain of command.

However, the GAO “found that military health care providers do not have a consistent understanding of their responsibilities in caring for sexual assault victims.”

The report noted that one command’s sexual assault policy, for instance, detailed when and where forensic exams should be conducted and the transfer of evidence to law enforcement — but had no provisions for restricted reporting, such as using non-identifying labels on evidence storage.

Another command had a policy that the chain of command be informed of all medical conditions affecting health, safety and readiness — without making an exception for sexual assault. “We met with senior medical personnel from the command who confirmed that provisions in their medical policy conflicted with other command policy and had created confusion for health care providers regarding the extent of their responsibility to maintain the confidentiality of victims who choose to make a restricted report of sexual assault,” the report said.

The report also said that sexual-assault first responders were not always aware of available health care options and that the services had lagged in ensuring responders underwent the required annual training.

The report published last week recommended that the Defense Department issue guidance for policies dealing with restricted reports, which were made available to female troops in 2005 in the wake of a spotlight on what appeared to be high rates of military sexual assault and low rates of victims seeking help. Surveys have shown that military women often do not report victimization because they don’t want others to know.

The gaps in sexual-assault response were discussed as part of a performance audit mandated by law to assess the availability of health care for deployed servicewomen.

On that score, overall, the GAO found, the services did well or were working quickly to make fixes. But the report also found that deployed women who are sexually assaulted face unique barriers to care, such as providers not trained to do forensic exams and difficulties due to weather in transporting victims elsewhere for care.

In response to the report, the Defense Department said it agreed that steps should be taken to improve compliance with the annual training. It said it disagreed with the recommendation to issue guidance, saying that guidance, “Sexual Assault Prevention and Response Program Procedures,” had been ongoing for nearly two years.